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Intraventricular Hemorrhage (IVH) in Infants

IVH is a serious condition caused by bleeding (hemorrhage) in the ventricles. Ventricles are chambers in the brain that hold cerebrospinal fluid (CSF). The fluid circulates from the ventricles into the spinal column. In premature infants, the ventricles are lined with tiny, fragile blood vessels making them more susceptible to IVH. Changes in blood pressure can cause them to bleed. This is IVH. Blood in the ventricles can keep fluid from circulating normally. If IVH occurs, it’s almost always within 5 days after birth.

How is IVH diagnosed and treated?

Ultrasound, a noninvasive imaging test, is used to look at the brain for signs of bleeding. Babies born at less than 32 weeks’ gestation (more than 6 weeks premature) will have a brain ultrasound. If IVH is detected, it is assigned a grade of 1 (mild) to 4 (severe). The grade is based on the amount of bleeding, and whether blood is getting out of the ventricles into the brain tissue. Medicines may be used to decrease the amount of CSF the body produces. Other treatments may be needed if complications develop.

What are the long-term effects?

The outcome depends on how severe the problem is. Many babies have less severe IVH (grade 1 or 2). These babies will have few or no lasting effects. Babies with more severe disease may have serious complications. These complications can include neurological damage and developmental delays. Babies with grade 3 IVH may require treatment for hydrocephalus (see below). Grade 4 IVH is very likely to cause hydrocephalus, leading to more serious long-term problems. But many babies with grade 3 IVH, and even some with grade 4 IVH, have only minor long-term problems.

What is hydrocephalus?

This condition occurs when fluid becomes trapped in the ventricles. This causes swelling, which puts pressure on the brain tissue. A baby’s skull is soft. This means it can expand. The baby's head circumference may be measured to monitor these changes. The main outward sign of hydrocephalus is that the baby's head gets larger. If swelling continues, pressure on the brain can increase. In some cases, swelling goes down without treatment. But if pressure is not relieved, it can cause brain damage. Treatments for hydrocephalus include:

Lumbar puncture (spinal tap). Draws fluid from the spinal column.

A shunt or a ventricular tap draws fluid directly from the ventricle in the brain.

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